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1 COLORADO DEPARTMENT OF TRANSPORTATION STORMWATER FIELD INSPECTION REPORT - ACTIVE CONSTRUCTION (1) Project Name: (2) Project Contractor: (3) Erosion Control Supervisor/SWMP Administrator: (4) CDOT Project Engineer/Representative: (5) Inspector(s) (Name and Title): (6) CDOT Project Number: (7) Project Code (Sub Account #): (8) CDPS-SCP Certification#: (9) CDOT Region: (11) Weather at Time of Inspection: (10) Date of Project Inspection: (12) REASON FOR INSPECTION / EXCLUSION Routine Inspection: (minimum every 14 Calendar Days) Runoff Event: (Post-storm event inspections must be conducted within 24 hours after the end of any precipitation or snowmelt event that causes surface erosion. If no construction activities will occur following a storm event, post-storm event inspections shall be conducted prior to re-commencing construction activities, but no later than 72 hours following the storm event. The occurrence of any such delayed inspection must be documented in the inspection record.) Routine inspections still must be conducted every 14 calendar days. Storm Start Approximate End Time of Storm (hrs): Third Party Request: Winter Conditions Inspections Exclusion: Inspections are not required at sites where construction activities are temporarily halted, snow cover exists over the entire site for an extended period, and melting conditions posing a risk of surface erosion do not exist. This exception is applicable only during the period where melting conditions do not exist, and applies to the routine 14-day inspections, as well as the post-storm-event inspections. If visual inspection of the site verifies that all of these conditions are satisfied, document the conditions in section 18 (General Notes) and proceed to section 19 (Inspection Certification). Documentation must include: dates when snow cover occurred, date when construction activities ceased, and date when melting conditions began. Other: (13) SWMP MANAGEMENT (14) CURRENT CONSTRUCTION ACTIVITIES: (a) Is the SWMP notebook located on site? (b) Are changes to the SWMP documents noted and approved? (c) Are the inspection reports retained in the SWMP notebook? (d) Are corrective actions from the last inspection completed? (e) Is a Spill Prevention Control and Countermeasure Plan retained at the project site? (f) Is a list of potential pollutants retained at the site? Yes No NA Estimate of disturbed area at the time of the inspection: Acres (15) BMPs ON SITE AT TIME OF INSPECTION *See Inspection Report Instructions for more detail. (a) EROSION CONTROL BMPs ON SITE In SWMP Used Not Needed at this time Seeding Mulching/Mulch Tackifier Soil Binder Soil Retention Blankets Embankment Protector* Grading Techniques* Berm/Diversion Check Dams* Outlet Protection* Other: (c) BMPs FOR SPECIAL CONDITIONS Dewatering Structure Temp. Stream Crossing Clear Water Diversion Sensitive Area Fencing Other: page 1 of 5 In SWMP Used Not Needed at this time (b) SEDIMENT CONTROL BMPs ON SITE Stabilized Const. Entrance Sediment Trap Inlet Protection* Sediment Basin Perimeter Control* Other: (d) MATERIALS HANDLING, SPILL PREVENTION, WASTE MANAGEMENT AND GENERAL POLLUTION PREVENTION Stockpile Management* Materials Management* Concrete Waste Management* Saw Water Management* Solid Waste/Trash Management Street Sweeping Sanitary Facility* Vehicle and Equip. Management Other:

2 (16) CONSTRUCTION SITE ASSESSMENT & CORRECTIVE ACTIONS **Off site Pollutant Discharges are a Violation of the Permit and Reason for Immediate Project Suspension** The construction site perimeter, all disturbed areas, material and/or waste storage areas that are exposed to precipitation, discharge locations, and locations where vehicles access the site shall be inspected for evidence of, or the potential for, pollutants leaving the construction site boundaries, entering the stormwater drainage system, or discharging to state waters. If there is evidence of sediment or other pollutants discharging from the site, see section 17 (Construction Site Assessment). All erosion and sediment control practices identified in the SWMP shall be evaluated to ensure that they are maintained and operating correctly. Identify the condition of the BMP, using more than one letter if necessary: (I) Incorrect Installation; (M) Maintenance is needed; (F) BMP failed to operate; (A) Additional BMP is needed; (R) Remove BMP. Keep copies of this blank page for additional room if needed. Continuous maintenance is required on all BMPs. BMPs that are not operating effectively, have proven to be inadequate, or have failed must be addressed as soon as possible, immediately in most cases. Location BMP Condition Comments: Description of Corrective Action and Preventative Measure Taken Date Completed & Initials page 2 of 5

3 (17) CONSTRUCTION SITE ASSESSMENT:**OFF SITE POLLUTANT DISCHARGES ARE A VIOLATION OF THE PERMIT AND REASON FOR IMMEDIATE PROJECT SUSPENSION** (a) Is there evidence of discharge of sediment or other pollutants from the site? Yes No *If yes, explain the discharge and the corrective actions in section 16 (Construction Site Assessment & Corrective Actions) or section 18 (General Notes). (b) Has sediment or other pollutants discharging from the site reached state waters? Yes No *If yes, see subsection (c) and Part II A.2 and 3 of the permit for reporting requirements. (18) GENERAL NOTES (19) INSPECTION CERTIFICATION I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Contractor s Erosion Control Supervisor/SWMP Administrator (Signature Required) CDOT Project Engineer/CDOT Designee (Signature Required) (20) COMPLIANCE CERTIFICATION Corrective action(s) has been taken, or where a report does not identify any incidents requiring corrective action, the report shall contain a signed statement indicating the site is in compliance with the permit to the best of the signer s knowledge and belief. Contractor s Erosion Control Supervisor/SWMP Administrator (Signature Required) CDOT Project Engineer/CDOT Designee (Signature Required) page3 of 5

4 Stormwater Management Field Inspection Report Instructions State waters are defined to be any and all surface and subsurface waters which are contained in or flow through the state, including, streams, rivers, lakes, drainage ditches, storm drains, ground water, and wetlands, but not including waters in sewage systems, waters in treatment works or disposal systems, waters in potable water distribution systems, and all water withdrawn for use until use and treatment have been completed. (Per subsection and (19) CRS) (3) Erosion Control Supervisor/SWMP Administrator: Indicate the name of the individual responsible for implementing, maintaining and revising the SWMP. (4) CDOT Project Engineer/Representative: Indicate the name of the CDOT representative performing the inspection with the ECS/SWMP Administrator. This person should be the Project Engineer or an authorized representative. (9) CDPS-SCP Certification #: Indicate the Colorado Discharge Permit System (CDPS) Stormwater Construction Permit (SCP) (for Stormwater Discharges Associated with Construction Activities) certification number, issued by CDPHE, for the project which the report is being completed. Certification number can be found on the first page of the SCP. (12) Reason(s) for Inspection / Exclusion: Indicate the purpose for the inspection or exclusion. These inspections are required to comply with the CDOT Specifications and the CDPS-SCP. Routine Inspections. These inspections are required at least every 14 calendar days during active construction. Suspended projects require the 14 calendar day inspection unless snow cover exists over the entire site for an extended period of time, and melting conditions do not exist (see, Winter Conditions Inspections Exclusions). Runoff Event Inspection for Active Sites. See page 1 for definition. Third Party Request. Indicate the name of the third party requesting the inspection and, if known, the reason the request was made. Winter Conditions Inspections Exclusions. See page 1 for definition. An inspection does not need to be completed, but use this form to document the conditions that meet the Exclusion. Other. Specify any other reason(s) that resulted in the inspection. (13) SWMP Management: Review the SWMP records and documents and use a to answer the question. To comply with CDOT Standard Specifications and the CDPS-SCP, all of the items identified must be adhered to. If No is checked, document the reason and indicate the necessary corrective action in section 16 (Construction Site Assessment & Corrective Actions). If NA is checked, indicate why in the space provided or indicate in section 18 (General Notes). (a) Is the SWMP notebook located on site? A copy of the SWMP notebook must be retained on site, unless another location, specified by the permit, is approved by the Division. (b) Are changes to the SWMP documents noted and approved? Indicate all changes that have been made to any portion of the SWMP notebook documents during construction. Changes shall be dated and signed at the time of occurrence. Amendments may include items listed in subsection (c). (c) Are the inspection reports retained in the SWMP notebook? The ECS/Engineer shall keep a record of inspections. Inspection reports must identify any incidents of non-compliance with the terms and conditions of the CDOT specifications or the CDPS-SCP. Inspection records must be retained for three years from expiration or inactivation of permit coverage. (d) Are corrective actions from the last inspection completed? Have corrective actions from the last inspection been addressed? Is a description of the corrective action(s), the date(s) of the corrective action(s), and the measure(s) taken to prevent future violations (including changes to the SWMP, as necessary) documented? (e) Is a Spill Prevention Control and Countermeasure (SPCC) Plan retained in the SWMP notebook? Subsection (c) requires that a SPCC plan be developed and implemented to establish operating procedures and that the necessary employee training be provided to minimize accidental releases of pollutants that can contaminate stormwater runoff. Records of spills, leaks or overflows that result in the discharge of pollutants must be documented and maintained. Information that should be recorded for all occurrences include the time and date, weather conditions, reasons for spill, etc. Some spills may need to be reported to the Water Quality Control Division immediately. (f) Is a list of potential pollutants retained at the site? Subsection (b)6 requires the Erosion Control Supervisor to identify and describe all potential pollutant sources, including materials and activities, and evaluate them for the potential to contribute pollutants to stormwater discharge. (14) Current Construction Activities: Provide a short description of the current construction activities/phase at the project site; include summary of grading activities, installation of utilities, paving, excavation, landscaping, etc. - Estimate the acres of disturbed area at the time of the inspection. Include clearing, grading, excavation activities, areas receiving overburden (e.g. stockpiles), demolition areas and areas with heavy equipment/vehicle traffic, installation of new or improved haul roads and access roads, staging areas, borrow areas and storage that will disturb existing vegetative cover. (15) BMPs On Site at Time of Inspection: Indicate the BMPs that are installed on-site at the time of inspection. All BMP details (e.g., Standard Plan M-208-1) shall be included with the SWMP documents. page4 of 5

5 Stormwater Management Field Inspection Report Instructions (continued) BMPs In SWMP/Used/Not Needed at this Time. This section can be used as follows: If the BMP is required by the SWMP and implemented, indicate by placing a in both the In SWMP and Used columns. If the BMP is required by the SWMP, but not implemented, indicate by placing a in the In SWMP and Not Needed at this Time columns. (a) Erosion Control BMPs On Site - Embankment Protector (e.g., temporary slope drains, open-chute drains, etc.) - Grading Techniques (e.g., vertical tracking, scarifying, or disking the surface on the contour, etc.) - Check Dams (e.g., rock check, erosion logs, erosion bales, silt berms, etc.) - Outlet Protection (e.g., riprap, erosion log around top of headwall, etc.) (b) Sediment Control BMPs On Site - Inlet Protection (e.g., erosion logs, erosion bales, sand bags, gravel bags, etc.) - Perimeter Control (e.g., silt fence, erosion logs, berms, etc.) (d) Materials Handling, Spill Prevention, Waste Management and General Pollution Prevention - Stockpile Management. Stockpiles shall be located away from sensitive areas. All erodible stockpiles (including topsoil) shall be contained by silt fence, berms or other sediment control devices throughout construction (also see subsection ). - Materials Management. Material that could contribute pollutants to stormwater shall have secondary containment or other equivalent protection (also see subsection (a). - Concrete Waste Management. All concrete residue shall be contained in a signed structure as designed per subsection (j) and subsection (n). It shall be located a minimum of 50 feet from state waters. - Saw Water Containment (e.g., pick-up broom or vacuum). Street washing is not allowed. - Sanitary Facility. Temporary sanitary facilities shall be located 50 feet away from drainage ways, inlets, receiving waters, and located away from areas of high traffic, and areas susceptible to flooding or damage by construction equipment. (16) Construction Site Assessment & Corrective Actions: Inspect the construction site and indicate where BMP feature(s) identified in section 15 (BMPs On Site at Time of Inspection), require corrective action. Erosion and sediment control practices identified in the SWMP shall be evaluated to ensure that they are operating correctly. - Location. Site location (e.g., project station number, mile marker, intersection quadrant, etc.). - BMP. Indicate the type of BMP at this location that requires corrective action (e.g., silt fence, erosion logs, soil retention blankets, etc.). - Condition. Identify the condition of the BMP, using more than one letter (identified in section 16) if necessary. - Description of Corrective Action and Preventative Measure Taken. Provide the proposed corrective action needed to bring the area or BMP into compliance. Once corrective actions are completed, state the measures taken to prevent future violations and ensure that the BMPs are operating correctly, including the required changes made to the SWMP. - Date Completed & Initials. Date and initial when the corrective action was completed and the preventative measure statement finished. (17) Construction Site Assessment: Was there any off site discharge of sediment at this site since the last inspection? (a) Is there evidence of discharge of sediment or other pollutants from the site? Off site pollutant discharges are a violation of the permit. The construction site perimeter, all disturbed areas, material and/or waste storage areas that are exposed to precipitation, discharge locations, and locations where vehicles access the site shall be inspected for evidence of, or the potential for, pollutants leaving the construction site boundaries, entering the stormwater drainage system, or discharging to state water. (b) Has sediment or other pollutants discharging from the site reached state waters? Off site pollutant discharges are a violation of the permit. If off site discharge has occurred, explain the discharge and the corrective actions in section 16 (Construction Site Assessment & Corrective Actions) or section 18 (General Notes). (18) General Notes: Indicate any additional notes that add detail to the inspection; this may include positive practices noted on the project. (19) Inspection Certification: In accordance with Part I, F.1.c of the CDPS-SCP, all reports for submittal shall be signed and certified for accuracy. (20) Compliance Certification: In accordance with Part I, D.6.b.2.viii of the CDPS-SCP, compliance shall be certified through signature. page5 of 5

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